Gangrene of tips of fingers and toes, cancrum oris, septicemia, candidosis, reactivation of pulmonary tuberculosis,

Other uncommon complications - Gangrene of tips of fingers and toes, cancrum oris, septicemia, candidosis, reactivation of pulmonary tuberculosis, possibly abortion or prematurity if infection occurs during pregnancy. Diagnosis - can be confirmed retrospectively with paired serology, salivary antibody detection is a non-invasive method of confirming the diagnosis Differential Diagnosis - PRE EXANTHEMATOUS STAGE - Common cold, influenza, catarrhal stage of whooping cough EXANTHEMATOUS STAGE - 1. Rubella - No Koplik's spots, small shotty enlargement of suboccipital, posterior cervical and post-auricular lymphnodes, catarrhal symptoms and systemic disturbances slight In measles mucous membrane is injected and dirty, in rubella it is pale and clean. 2. Drug eruption - especially that caused by ampicillin Tends to persist longer and may have an urticarial element Absence of catarrh and failure of rash to evolve from above downwards. 3. Serum rashes - Rash dense at site of injection, typical wheals. 4. Infectious mononucleosis - Fever, adenopathy, and sore throat Maculopapular rash, splenomegaly Atypical lymphocytes in blood smear. 5. Erythema infectiosum - Rash but usually no constitutional symptoms. Rash appears in three phases. It begins with livid erythema of the cheeks (slapped cheeks), followed by maculopapular rash on extremities and trunk, and as the rash fades it has a lacy reticular appearance. 6. Roseola infantum (Exanthema subitum) - Acute viral disease of young children. 3 to 4 days of high fever As fever falls by crisis, pink maculopapules appear on chest and trunk and fade in 1 -3 days. 7. Erythema multiforme - Circular or irregular erythematous blotches usually occurring on backs of hands and forearms. Constitutional symptoms may be present. 8. Other exanthemas - (a) .Coxsackie virus A. Hand-foot and mouth disease is the most specific syndrome. After a short prodroma of malaise, anorexia and fever, a vesicular exanthem develops involving buccal mucosa. A vesicular exanthem also appears on hands and feet in many patients. (b) Other viral infections -Adenovirus, parainfluenza virus, respiratory syncitial virus may occasionally be associated with macular or maculopapular rashes. 9. Paratyphoid - Sometimes profuse pinkish brown maculopapules. Longer prodromal illness, characteristic temperature chart, agglutination test positive .10. Typhus - Early prostration, mental symptoms, rash bright red, subcuticular mottling, no well defined edges, not marked on face. 11. Scarlet fever - Short prodromal period, sore throat, anterior cervical adenitis, scarlet rash, circumoral pallor and punctuate hemorrhages. Skin folds in groin, neck, axillae and knees become dark red (Pastia's lines) Circumoral pallor is common and skin often has a fine sandpaper texture. Strawberry tongue Management - Bed rest in quiet shaded room during febrile period Frequent fluid intake Paracetamol for fever Irrigation of eyes with boric lotion. Cough linctus to suppress the dry cough Antibiotics such as ampicillin if complications such as otitis media or pneumonia. Should be given prophylactic ally to 'poor-risk1 children. Vitamin A 200,000 units IU orally for 2 days, will prevent ocular complications and reduce respiratory infections and measles-related mortality Prevention - (a) ACTIVE IMMUNIZATION - Single dose of attenuated live-virus vaccine for all children at the beginning of second year of life. Contraindications - Personal history of convulsions, intercurrent illness or recent exposure to other infectious disease, those receiving corticosteroids, or other immunosuppressive agents, leukemia, tuberculosis, and in any stage of pregnancy. Untoward effects- Febrile reaction after one week, sometimes rash Rarely convulsions and very rarely encephalitis. Acyclovir may be used to treat secondary herpetic infection. Oral and intestinal candidosis require antifungal treatment. (b). PASSIVE IMMUNIZATION - with immunioglobulin is useful in debilitated patients in contact of measles patients followed in 3 months by vaccine. Dose 0 25 ml/kg IM It should be given within 5 days of exposure RUBELLA (German Measles) Etiology - Causative agent - Rubella is an exanthema caused by an RNA virus of the togavirus family Transmission - Droplet inhalation from an infected person Neonates with congenital infection are prominent shedders of the virus, which may be found, often as long as G months Incubation period -14-21 days Period of infectivity-from 7 days before to 4 days after appearance of rash. Clinical features - Exanthem - Rash occurs more often in older children and adults on first or second day of illness, first on face and behind the ears, and then spreads downwards to trunk and limbs. The predominant lesion is a pink macule, although maculopapular and hemorrhagic elements may be found. The rash seldom persists for more than 4 days and is not followed by staining or desquamation. Rubella without rash is common in young children. In a dark-skinned patient all that may be seen is prominence of hair follicles giving a goose-pimpled appearance. Lymphadenopathy -Slight enlargement of lymphnodes, particularly of suboccipital and posterior auricular groups Buccal mucous membranes - are inflamed, with blotchy erythema and prominent follicles on soft palate, accompanied by mild conjunctivitis and coryza